Free government health services often go unused

In many parts of the world, people have little access to health services, and this lack leads to increased sickness and death. Even more tragically, there are parts of the world where health services do exist, yet people are unable to access them because health workers don't show up for work, or they divert government funds, or they ask poor patients for extra money in exchange for treatment.

Johns Hopkins researcher Mahdev Goyal says this is the case in many parts of India. But Goyal also says part of the problem is that people don't know they're entitled to government services and so they don't challenge corrupt or lazy health workers when they don't do their jobs.

Goyal and several colleagues thought that teaching people about their rights might empower them to use them. So, they created educational materials to teach poor villagers in the Indian state of Uttar Pradesh about available government health services.

They went to 105 villages, randomly selecting which villages would get information and which ones wouldn't. They taught the villagers what services they were entitled to as well as the legal controls they had over the people providing the services.

"We wanted to see if there was a difference," says Goyal. "Were people who got the information also able to better procure the services?"

One area they focused on was the delivery of health services for women and children. "For example, if there was a pregnant woman in the home, she was guaranteed a prenatal exam; she was guaranteed prenatal supplements every three months; she was guaranteed a delivery, a free delivery by the nurse midwife," Goyal explains. "We informed them of these basic services, but we also informed them that, look, this is where you can go to complain if you're not getting the services, or if the services are not being provided in the way they're supposed to be."

Goyal and his colleagues went to the villages, held public meetings and played a prepared tape with a lecture about the services. They also handed out information fliers to people who were able to read.

The result: once the villagers knew what they were entitled to, many were more likely to demand the services. Goyal says they found that villagers even challenged delinquent workers, asking them why they weren't doing their jobs.

And improvement in health outcomes was measurable. In looking at prenatal examinations, tetanus vaccinations for pregnant women, prenatal supplements for pregnant women, and infant vaccinations for children or infants who were less than a year old, Goyal says, "we found that all of these went up in the intervention villages by between 25 to 30 percent."

Goyal says he and his team are planning to return to India, to teach more villagers about what health services they are entitled to.

His paper is published in the Journal of the American Medical Association as part of a theme issue on poverty and development. This issue of JAMA is one of more than 200 international journals publishing articles simultaneously on the topics of poverty and human development.